Racial and Ethnic Disparities in Adverse Pregnancy Outcomes Among Women with Early Onset Cancer in the United States

Despite well-established racial/ethnic disparities in cancer outcomes, little is known about the extent to which race/ethnicity influences adverse pregnancy outcomes (APOs) among women with early onset cancer. We evaluated racial/ethnic disparity in the occurrence of cancer during pregnancy and APOs among women with cancer in the United States.

Data consisted of 17.6 million singleton deliveries among females aged 18-49 years from the National Inpatient Sample. Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

From 2000 to 2022, the prevalence of births among women with cancer increased more than 225%, from 120.4 to 391.8 per 100,000. After accounting for sociodemographic and behavioral/lifestyle factors and comorbidity index among women with cancer (n = 49,824, mean age = 33.4 years), non-Hispanic Black women had the highest odds for hypertensive disorders of pregnancy (OR = 1.67, CI: 1.54-1.82), preterm birth (OR = 1.44, CI: 1.26-1.64) and fetal death (OR = 3.04, CI: 1.99-4.63). Asian or Pacific Islander and Native American women had the highest odds for gestational diabetes (OR = 2.48, CI: 2.17-2.85) and fetal growth restriction (OR = 1.92, CI: 1.00-3.69), respectively. Among racial/ethnic minority women, the odds for maternal mortality and several APOs were significantly higher among those with cancer than those without cancer, with the odds for APOs being highest for breast cancer (OR = 1.39, CI: 1.23-1.56).

This large population-based study showed significant racial and ethnic disparities in APOs among women with a concurrent cancer diagnosis at delivery. Targeted management of APO risk factors during pregnancy among racial/ethnic minority populations with cancer may help reduce adverse maternal and neonatal outcomes.